JACKSON – Last week, almost quietly, the Mississippi House voted down a proposal to expand Medicaid to cover people earning up to 138 percent of the federal poverty level as is allowed under the federal Patient Protection and Affordable Care Act.

In 2013, funding of the existing Mississippi Medicaid program almost came to a halt as Democrats and Republicans battled over whether to expand Medicaid. Speaker Philip Gunn, R-Clinton, used unusual parliamentary rules to prevent Democrats from having an opportunity to bring the proposal up for a vote on the floor of the House.

Finally, in special session last year, days before the existing Medicaid program was set to be unfunded and repealed, Democrats figured out a way to get a vote on the issue. They offered an amendment saying the existing Medicaid program would not be funded until Medicaid was expanded. The rules allowed such an amendment.

That amendment was defeated in the June special session along party lines. Democrats then joined with Republicans to fund the existing program. On Friday, Rep. Cecil Brown, D-Jackson, offered the amendment again. The results were the same. The amendment garnered 52 yes votes, all Democrats, and 64 no votes, which included one Democrat. After that vote, the Medicaid budget passed with no dissenting votes.

The Republican leadership has successfully prevented a general bill from being presented to the chamber dealing with Medicaid expansion. The only alternative allowed under the House rules is the proposal saying Medicaid must be expanded before the existing program was funded.

On Friday, House Medicaid Chair Bobby Howell, R-Kilmichael, argued that passing Brown’s amendment would put the existing program in jeopardy. But Brown argued that it would not, saying it was early in the budgeting process.

Democrats say it is important to offer the expansion amendment even if they know it will not pass because it keeps the issue alive. And they claim that as more Mississippians learn their political leaders are turning down on average $3 million per day in federal funds for health care that is going to other states that public support in the state for expanding Medicaid will grow.

Brown said other states are expanding Medicaid. By not expanding, Brown said, Mississippi will continue to fall further behind the rest of the nation in terms of health outcomes. He urged legislators to talk to clerks, waiters and laborers when they returned home and ask if they had health insurance.

“These are working people,” Brown said, adding legislators work part time, yet get state-funded health insurance.

While Gunn had tried in the past to block the issue from coming to the floor for a vote, some Republicans indicated they do not mind voting on the issue. House Appropriations Chair Herb Frierson, R-Poplarville, thanked Democrats on Friday for offering the Medicaid expansion amendment, saying it helps him in his district to have another vote against Obamacare.

Gov. Phil Bryant and legislative leadership have been adamant in their opposition to Medicaid expansion, saying the state cannot afford it.

“It appears Obamacare is a debacle,” Gunn said in December. “I cannot believe anybody would continue to advance it.”

For the first three years of the Medicaid expansion portion of the Affordable Care Act, the federal government pays 100 percent of the health care costs. It eventually stair-steps down to 90 percent of the health care costs associated with the expansion paid by the federal government in 2020. It is supposed to remain at that level.

Bryant and Republicans argue there is no guarantee the federal government will continue to pay 90 percent of the costs after 2020. Democrats counter that the same can be said for any joint program the state participates in with the feds, but the federal government has been consistent since the 1960s in meeting its commitment to the existing Medicaid program.

It has been estimated that the expansion could provide coverage to as many as 300,000 people, mostly the working poor.

Under the expansion an individual earning up to about $15,000 per year, or $32,000 for a family of four, would be eligible.

Mississippi, the poorest state in the nation, still has the best matching rate with the federal government providing about 73 cents of every $1 on health care for the 640,000 elderly, disabled, poor pregnant women, and poor children on the existing Medicaid program. Nationwide, the average matching rate for the federal government is a little more than 57 percent, according to the Kaiser Family Foundation.